1. Shikha Bhatia Radiology elective 06/02/17
Case Presentation
Shikha Bhatia
Radiology elective
06/02/17

2. J. P. 25 y/o M
Presented to Ed C/o persistent headaches over several months
Feels dull & in the back of his head with intermittent, sharp neck pain
Headaches worse over last week, esp in AM, and associated with dizziness
No weight loss, night sweats, GI upset
Previously seen in culpepper, dx’ed cervical strain
Moved from Honduras 3 years ago
Cuts trees for work
Pex: No papilledema, Narrow station, Unsteady tandem gait, o/w normal
Labs: ↑ lfts, o/w normal

3. 1. Large cystic mass with single area of internal calcification located in the left central posterior fossa causing mild to moderate hydrocephalus, mild transependymal CSF flow, and cerebellar tonsillar herniation.

13. Differential Large posterior fossa mass in 25 y/o
primary brain tumor
Pilocytic astrocytoma
Medulloblastoma
glioblastoma
Metastatic brain tumor
Cystic lesions
Neurocystercircosis
Echinococcocis
Cystic glioma
Pyogenic abscess
Tuberculoma
Mycotic Granuloma
Toxoplasmosis
Nocardia

14. Neurocystercircosis
Parasitic disease cause by t. solium, which is endemic in south America, asia, and Africa
Weeks to years following ingestion, tissue cysticerci develop in various sites, including the brain
Symptoms depend on location – seizures (Intraparencymal) and HA, n/v (subarachnoid)
Diagnosis – Imaging most common, but Serology, Fundoscopic exam, Spinal studies and biopsy may also aid
Treatment – antiparastics, anti-inflammatories, surgery

15. Imaging findings Imaging findings vary based on stage of infection
Vesicular – cystic, hypodense, round
Colloid vesicular – cyst begins to degenerate: cyst wall and cavity increases In intensity, surrounding enhancement 2/2 edema
Granular Nodular – Cyst retracts, edema decreases, decreased enhancement
Nodular calcified – calcified granuloma, no enhancement
Only pathognomonic findings = scolex
Elongated, bright nodule within cyst cavity (Fig. B)
Enhancing lesions and parenchymal calcifications are also highly suggestive; May also p/w hydrocephalus and leptomeningeal enhancement

16. What happened? Neurosurgery consulted
Suboccipital craniotomy with resection
“The wall of the lesion was opened, and a white-colored tendril was unraveled and pulled from inside the cyst”
c/b hemorrhage requiring evacuation and aneurysm clipping
Uncomplicated recovery following
Discharged post-operative day 22 once stable
Given baclofen, meclizine, Zofran, and scopolamine patches, with continued rehab

17. References
Gaillard, Frank. "Neurocysticercosis." Radiopaedia. 01 Jan Web. 01 June 2017.
White AC, Weller PF, and Baron EL. "Clinical Manifestations and Diagnosis of Cystercercosis." UpToDate. 16 DEC Web. 31 May 2017.

18. Questions?